Response:

We thank Dr Reddy and colleagues1 for their interest in our article "Management of recurrent symptoms after per-oral endoscopic myotomy in achalasia."2 Those authors point out that the response to pneumatic dilation (PD) after failed per-oral endoscopic myotomy (POEM) was low in our study, and we entirely agree. Only 20% of the patients responded to PD. The authors of the letter suggest this was due to our dilation scheme of using 30 and 35 mm, not using 40 mm. However, we think that further dilation up to 40 mm would probably not have added much to the efficacy.

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